May 2019
Impact
General
Critical Care
Zuckerberg San Francisco General Hospital and Trauma Center
San Francisco
,
CA
United States
Shannon Macfarlan, RN; Brooke Bassett, RN; Jen McGaugh, RN; Lawrence Chyall, RN, CNS
When palliative care is integrated into intensive care unit practice, patient and family health, as well as resource utilization, improve. The sustained integration of palliative care in the intensive care unit requires the involvement of nurses, the clinicians closest to the patient's bedside. Integrating Palliative Care into the Intensive Care Unit (IMPACT-ICU) is a quality improvement program designed to integrate palliative care into the ICU by training and supporting bedside RNs. In 2016, ZSFG received a grant from the California Foundation for Health Care Quality to the implementation of IMPACT-ICU at our hospital. A small group of dedicated RNs has been committed to building this program to support the RNs, patients, and families in our ICU.
IMPACT-ICU is comprised of an 8 hour learner-centered workshop that trains RNs to facilitate conversations about prognosis, goals of care, and palliative care among families and physicians. The workshops are led by the IMPACT-ICU team with support from the Department of Palliative and Supportive Care, and our Sojourn Chaplaincy. Using simulation, the team guides RNs through practice conversations with families and physicians. They also take nurses through a reflection session, teaching them about self-care practices to address distress and burnout. Given the importance of high-quality communication with families in our neurotrauma population, the IMPACT-ICU program has also become part of the performance improvement plan for the Department of Neurosurgery and now received support from the Neurotrauma Program.
To date, we have trained over 80 ICU RNs through these classes, and have set a goal to train all of our ICU RNs by 2021. Let me share some of the feedback provided by participants in their evaluations of the training:
"This class is amazing - I can't wait to bring what I learned to the bedside"
"(I learned how to) understand things from the patient/family perspective...(and) how to (understand) that family anger happens because they are having trouble coping"
"I feel more empowered in family meetings"
"Increased my confidence being active in family meetings - I have been more of an observer of family meetings in the past"
"I feel more empowered to speak up and advocate for my patients"
"The facilitation was amazing. I literally walked out of a class last week because there was role-playing. What they did in this class is beyond role-playing"
IMPACT-ICU is comprised of an 8 hour learner-centered workshop that trains RNs to facilitate conversations about prognosis, goals of care, and palliative care among families and physicians. The workshops are led by the IMPACT-ICU team with support from the Department of Palliative and Supportive Care, and our Sojourn Chaplaincy. Using simulation, the team guides RNs through practice conversations with families and physicians. They also take nurses through a reflection session, teaching them about self-care practices to address distress and burnout. Given the importance of high-quality communication with families in our neurotrauma population, the IMPACT-ICU program has also become part of the performance improvement plan for the Department of Neurosurgery and now received support from the Neurotrauma Program.
To date, we have trained over 80 ICU RNs through these classes, and have set a goal to train all of our ICU RNs by 2021. Let me share some of the feedback provided by participants in their evaluations of the training:
"This class is amazing - I can't wait to bring what I learned to the bedside"
"(I learned how to) understand things from the patient/family perspective...(and) how to (understand) that family anger happens because they are having trouble coping"
"I feel more empowered in family meetings"
"Increased my confidence being active in family meetings - I have been more of an observer of family meetings in the past"
"I feel more empowered to speak up and advocate for my patients"
"The facilitation was amazing. I literally walked out of a class last week because there was role-playing. What they did in this class is beyond role-playing"